探討腦中風個案參與急性後期照護之醫療成本分析
-以某區域醫院為例

研究目的現今人口罹患腦血管疾病持續增加且年齡逐年下修年輕化趨勢且後續龐大的醫療照護成本非常可觀，對病人、家庭及社會經濟層面都是一大負擔及挑戰。本研究目的除要了解影響腦中風病患參與急性後期照護相關因子外，並探討影響急性後期照護對腦中風病患醫療耗用、醫療療效及出院動向之成效。研究方法本研究為回溯性研究，研究時間從2014年03月01日至2016年02月28日，以參與腦中風急性後期照護病患進行研究。採用SPSS 20版統計套裝軟體，進行統計資料分析及驗證假說。研究結果一、參與急性後期照護病患僅達58位(10%)。以男性(62.1%)、不識字(37.9%)為主，平均年齡為65.53歲、平均住院總天數32.41天及總費用167,994元，較無參與急性後期照護病患顯著地高（p<.001）。此外，年齡愈高，住院日愈長（p=.10<.05）、有使用尿管的病患住院日及費用亦顯著多於無參與急性後期照護（p<.001）。二、在醫療療效方面，參與急性後期照護於90天再入院及一年內死亡風險各為無參與急性後期照護病患的0.54倍、0.23倍；依年齡每增加一歲，一年內死亡風險會提高4%；住院期間有使用尿管的病患，一年內死亡風險是沒有使用的3.37倍，顯示參與急性後期照護病患的醫療療效較無參與急性後期照護病患佳。三、在出院動向方面，參與急性後期照護病人絕大多數以回家居多（87.9%），其中又以有無使用尿管、昏迷指數變項影響轉介長期照護計畫（p<.01）。結論與建議結果發現人口學特性於參與急性後期照護與否無顯著影響。而臨床特質中，1級檢傷、轉ICU、自我照顧、出血型腦中風、尿管等對住院總天數及總費用方面有邊際或是顯著的影響，對出院返家自我照護則無。相對地，健保申報費用主要以復健治療補助為主，欠缺護理照護技術及管灌膳食費，使得病患住院越久花費就越多。建議將此護理照護技術及管灌膳食費列入考量，讓醫療資源運用更完善。

關鍵字

腦中風；急性後期照護；醫療成本分析

並列摘要

Background and Purpose The population suffering from cerebrovascular diseases continues to increase and there is upward trend among younger population,resulting in poor effectiveness in the utilization of medical resources. This study aims were to understand the effect factors of stroke patients’ participating PAC; to investigate the effect factors of PAC patients’ consuming medical resources, and to analyze the effectiveness of PAC on discharged from acute care to long-term care. Research Methods The study was a retrospective design collecting stroke data by a regional hospital from March 1, 2014 to February 28, 2016. The study used SPSS 20v software to analyze data, including descriptive statistics and inferential statistics for data arrangement and hypothesis test. Research Results I.There were 580 stroke patients in the study and only 10% (n=58) were to participate PAC project. 62.1% subjects of PAC were males, 37.9% subjects were illiteracies. and the 58 subjects’ average age was 65.53 years ’average length of stays (32.41 days) and hospitalization expense (NT 167,994) were significantly higher than non-PAC patients（p<.001）. Additionally, older persons (p=.10<.05) and use of foley（p<.001）also had more higher means of the consumption of medical resources. II. In terms of medical effects, the dead risks of PAC patients were 0.54 and 0.23 higher compared to non-PAC patients on readmitted within 90 days and dead within one year respectively; the odds with increasing one years old would raise 4% dead risk; the dead risks within one year of patients with foley was 3.37 higher compared to patients without foley. These results displayed the stroke patients who participation PAC project had better medical effects than non-participations. III.In terms of discharge destination, PAC patients were for the vast majority of home (87.9%) and foley-using and GCS significantly related with the outcomes (p<.01). Conclusion and Suggestion The major purposes of the study were to investigate the PAC effectiveness for stroke patients and the influence factors. The results showed that demographic characteristics were not the significant effect factors on participating PAC project. Meanwhile clinical characteristics, 1 level triage criteria, transiting ICU, self-care, hemorrhagic stroke, and foley-using had marginal or significant effects on the average length of stays and hospitalization expense, however discharge destination didn’t. In contrast, the majority of inpatient claim payment of acute post-care was in rehabilitation assistance and lack payment of nursing care techniques and nasogastric tube feeding and resulted in patients hospitalized longer spend the more. The study suggested that declare items could consider the payments of nursing care techniques and nasogastric tube feeding to improve the utilization of medical resources.